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Using Modifier 25 in Otolaryngology: Rewards and Ramifications

Recorded On: 03/23/2022

Using Modifier 25 in Otolaryngology: Rewards and Ramifications 

Total Runtime: 1 hour and 36 minutes

Cost: $249

Appending modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) to an Evaluation and Management (E/M) code, when also billing a minor procedure on the same day, typically results in payment for both services – the reward.  But is it correct?

Payors, including the Office of the Inspector General (OIG), have been auditing the proper use of modifier 25 and recouping millions of dollars from otolaryngologists – the ramification.  A common misconception is that the E/M code and procedure code are always billed together.  That’s just not true.  There are times when it is not appropriate to also report the E/M code but bill only the procedure.

We will examine the CPT guidelines about using modifier 25 as well as what Medicare says.  Several scenarios frequently encountered in otolaryngology practices will be reviewed.  You will have a better understanding of how to correctly use modifier 25 when performed with the common ENT minor procedures including:

  • Nasal endoscopy
  • Flexible laryngoscopy
  • Endoscopic sinus debridement
  • Excision of skin lesion, and
  • Cerumen removal

Presented by:

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Registering Multiple Attendees 

  1. Create, or have each attendee create, a user account here
    1. If one person is creating all of the accounts you will need to log out each time to create the next account.
  2. Log in with the account that you wish to pay through and add desired products to your cart. 
  3. Once you have selected all the desired products, go to your cart. 
    1. You will initially be registered for each product. You can edit this after you have added the additional attendees using the "remove" button.
  4. To add the additional attendees select the green button in your cart titled “Add a Registration for Another User.”
  5. Enter the email address for the additional attendee.  If they have an account their name will populate and you can select “Add Product for This User.”
  6. The attendee's name will appear in the registrant column under your own. 
  7. Repeat this for each additional attendee.
  8. Proceed, filling out the additional information for each attendee and completing payment.

If you have any issues with completing your registration please email us at education@karenzupko.com or call 312 642-8310 

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Course Handout
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Open to download resource.
Using Modifier 25 in Otolaryngology: Rewards and Ramifications
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Open to view video.
Course Evaluation
Webinar Evaluation
9 Questions
Post-Course
CEU Quiz
15 Questions  |  1 attempt  |  11/15 points to pass
15 Questions  |  1 attempt  |  11/15 points to pass
CEU Certificate
Up to 1.50 medical credits available  |  Certificate available
Up to 1.50 medical credits available  |  Certificate available